Because of problems with Medicare Part D, the old Medicaid drug coverage that was in effect until Jan. 1 will be reinstituted.

12:26 PM EST on Wednesday, January 11, 2006

BY FELICE J. FREYER
Journal Medical Writer

When Ina Storer called her pharmacy to fill 3 of her 25 prescriptions last week, she was told that only one of the drugs was covered, and she'd have to pay $35 for it. Disabled and destitute, Storer couldn't afford that -- and she broke down in tears.

Under the new Medicare Part D drug benefit, Storer, 63, is supposed to pay only $1 or $3 for each of her prescriptions, which she needs to treat diabetes, heart disease and kidney failure. But because of various computer glitches, she -- and numerous others -- are not in the pharmacists' systems, and unable to get their medications.

"This is horrible for me," Storer said in an interview in her Cranston home, where she lives alone. "I can't deal with the government. I'm not a lawyer."

While other New England states have instituted emergency plans to help people in Storer's situation, Rhode Island is just starting to respond.

Jeff Neal, spokesman for Governor Carcieri, said the governor plans to reinstitute the old Medicaid drug coverage that was in effect until Jan. 1. But he said that would take at least two days to accomplish.

Carcieri also wrote to U.S. Health and Human Services Secretary Michael Leavitt, asking him to intervene, and yesterday sent a letter to pharmacists urging them to "continue to do whatever you can to ensure that these beneficiaries receive the prescription medications they need."

On Monday, Massachusetts health officials simply ordered pharmacies to fill the prescriptions of certain Medicare beneficiaries, and then bill the state, according to The Boston Globe.

At issue are the 27,000 Rhode Islanders who are covered by both Medicare, the federal health plan for the elderly and disabled, and Medicaid, the state-run health plan for the poor. Until Jan. 1, their drugs were completely paid for by Medicaid. But now their drug coverage has been switched to Medicare Part D drug benefit, a complicated system of private health plans.

Here, as elsewhere around the country, it has not been a smooth transition.

Among the most vulnerable are people with severe, chronic mental illnesses, who often take many carefully calibrated medications, for both mental and physical ailments. Many don't understand the change that has taken place and lack the wherewithal to navigate the system, advocates say.

Elizabeth V. Earls, president of the Rhode Island Council of Community Mental Health Organizations, said that clients have been charged incorrect copayments, that pharmacists have been unable to access information about them, and that the federal government has deducted premiums from their Social Security checks, even though indigent people don't have to pay premiums.

"In four to six weeks," Earls predicted, "we're going to see a huge surge in hospitalizations. . . . It is scary."

At the South Shore Mental Health Center in Wakefield, Kathy Garlick, senior manager of the mobile treatment team, encountered a mentally ill man who just went two days without taking his heart medication.

"This is a man who had a heart attack a month ago," Garlick said. "He went into the pharmacy on his own over the weekend." Told he had to pay for the drugs, he replied that he didn't have the money and walked out. The staff at the mental-health center learned about this yesterday. By the end of the day, they hadn't figured out why he wasn't in the system -- but the pharmacy had agreed to provide a week's worth of medication.

Garlick estimates that three-quarters of her clients have encountered difficulties getting their medications.

One was a woman who had received her Medicare drug card, and was actually in the system -- but she needed preauthorization for her dosage of the antipsychotic drug Zyprexa. "I spent four hours on the phone," Garlick said. "I kept track." Eventually she obtained the necessary form, while the pharmacy gave the patient five days of drugs.

Ina Storer, the Cranston woman who needs 25 medications, has also spent a lot of time on the phone. She called her drug plan, and she called Medicare, and she called the state Department of Elderly Affairs. By late yesterday, she still had not straightened out her problem, but her pharmacy did agree to send "a couple of pills" to hold her over.

"This is making me very sick," Storer said. "I don't want to go back to the hospital over this."

ffreyer@projo.com / (401) 277-7397

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